Peroneal tendonitis is a common condition involving inflammation of the tendons that run along the outer side of the ankle and foot. These tendons stabilize the foot and ankle, especially when walking on uneven ground, and control the outward movement of the foot, known as eversion. When these structures become overworked, the resulting pain can make simple actions like walking difficult. Recovery requires a phased approach that transitions from immediate pain relief to long-term strengthening and prevention. This guide outlines a structured plan for addressing peroneal tendonitis and returning to full activity.
Understanding the Injury
The ankle is supported by two peroneal tendons, the peroneus longus and peroneus brevis, which originate in the lower leg and wrap behind the bony prominence on the outside of the ankle, the fibula. These tendons work together to stabilize the ankle joint and protect it from sprains, especially during movements that require the foot to turn outward. Peroneal tendonitis occurs when repetitive tension or friction causes inflammation and micro-tears in the tendon tissue.
Symptoms include a dull ache or throbbing pain along the outside of the ankle and foot that intensifies with activity. Swelling, warmth, and tenderness directly behind the outer ankle bone are common. The primary mechanical causes often involve a sudden increase in activity, such as a sharp rise in running mileage, or inadequate footwear that fails to support the foot’s structure. Individuals with high-arched feet are often at a higher risk because their foot structure places increased mechanical stress on the peroneal tendons.
Immediate At-Home Management
The initial phase of treatment focuses on reducing acute inflammation and pain, typically within the first 48 to 72 hours following the onset of symptoms. The standard approach for immediate care is the R.I.C.E. protocol, which stands for Rest, Ice, Compression, and Elevation. Rest involves completely stopping any activity that causes pain, potentially requiring a switch from high-impact exercise to non-weight-bearing options like swimming or cycling.
Applying ice to the affected area helps to constrict blood vessels, minimizing swelling and providing a localized pain-relieving effect. A cold pack wrapped in a towel should be applied for no more than 20 minutes at a time, with an hour break in between applications, several times a day. Compression, using an elastic bandage or compression sleeve, helps to reduce swelling by preventing fluid accumulation, but it should not be wrapped so tightly that it causes numbness or tingling.
Elevation involves keeping the injured ankle propped up above the level of the heart whenever possible, allowing gravity to assist in draining excess fluid. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be used during this acute phase to manage pain and reduce inflammation. However, it is recommended to consult a doctor before starting any medication regimen, especially for prolonged use.
Progressive Rehabilitation and Strengthening
Once the acute pain and swelling have subsided, the next phase involves a gradual, structured rehabilitation program to restore strength and flexibility to the tendons and surrounding muscles. Strengthening the peroneal tendons is accomplished through specific resistance exercises, with one of the most effective being resisted ankle eversion. This exercise uses a resistance band looped around the forefoot, with the other end anchored, requiring the foot to slowly turn outward against the band’s tension.
Another foundational exercise is single-leg standing, which directly trains the peroneal tendons in their role as ankle stabilizers. Starting by balancing on the affected leg for 30 seconds, and gradually progressing to performing the exercise with eyes closed, helps to improve proprioception and dynamic stability. Integrating heel raises, focusing on the upward movement over the ball of the big toe, further strengthens the entire calf and ankle complex, provided the movement is controlled and pain-free.
Flexibility is addressed through stretching the calf muscles, which reduces tension transferred to the peroneal tendons. A simple wall stretch, where the back leg is kept straight and the heel on the floor, effectively targets the superficial calf muscles. A seated towel stretch can also gently improve ankle dorsiflexion and lengthen the posterior leg muscles.
Long-Term Prevention
Long-term prevention requires addressing biomechanical factors, often through the use of supportive footwear with rigid soles or custom orthotics. These devices can correct foot positioning and redistribute pressure away from the irritated tendons.
When Professional Intervention is Necessary
While many cases of peroneal tendonitis respond well to conservative at-home management, there are clear indicators that professional medical evaluation is needed. If the pain persists intensely for longer than two weeks, if there is a sudden inability to bear weight, or if localized swelling and heat dramatically worsen, a consultation with a healthcare provider is warranted. These symptoms may signal a more serious underlying issue, such as a degenerative tear or a tendon subluxation, where the tendon slips out of its groove.
A general practitioner can provide an initial diagnosis and refer the person to a specialist, such as a physical therapist or an orthopedic specialist. A physical therapist develops a formal rehabilitation program, utilizing techniques like dry needling, manual therapy, or ultrasound to promote healing. For persistent pain, an orthopedic specialist may consider a corticosteroid injection to reduce inflammation, though repeated injections are avoided due to the risk of weakening the tendon tissue. Surgery is reserved for chronic, severe cases, such as a large tendon tear, or when the tendon is unstable and repeatedly dislocates. Surgical procedures involve cleaning out damaged tissue or repairing a torn tendon, followed by a lengthy rehabilitation process.